Table 2.

List of Challenges Implementing Diabetes Prevention Program Within an Integrated Health Care Delivery System and Resources and Opportunities for Program Improvement

Ongoing challenges	Resources needed and opportunities for program improvement
Increasing the percentage of providers who refer prediabetic patients to DPP	Provision of provider performance feedback on rates of referral, enrollment status of their patients, and patient progress
	Offer periodic training on referral process to providers
	Inclusion of percent of patients with prediabetes referred to DPP in ambulatory care performance measures
Reducing time between patient referral and class enrollment	Commitment to flexible staffing models allows for ongoing engagement with referred patients
	Training of additional allied health staff as DPP lifestyle coaches
Engaging special populations (eg, men, adolescents)	Offer adapted curriculum (ie, condensed classes, different class time line, virtual classes)
	Use of peer leader model
Class retention	Use EHR to capture patient barriers to enrollment and attendance (eg, transportation, childcare) in structured data fields and develop strategies to address barriers
	Assess the impact of incentives to participation (eg, calorie counters, pedometers, MetroCards)
DPP class reimbursement	Where possible, create in-house reimbursement for patients in risk-based and/or capitated contracts
	Medicare reimbursement for DPP starting in 2018 sets precedent for other payors

DPP, Diabetes Prevention Program; EHR, electronic health record.